6. Thinking blocks / decision making problems in ADHD
- 6.1. Thinking blocks as an ADHD symptom
- 6.2. Decision-making problems as an ADHD symptom
- 6.3. Neurophysiological correlates of thinking blocks and decision making problems
- 6.4. Thought blocks as symptoms of stress
6.1. Thinking blocks as an ADHD symptom
Thinking blocks are a phasic impairment of cognitive performance, usually caused by a large acute stress load.
A typical example of thinking blocks are exam blackouts.
Thinking blocks occur with about equal frequency in ADHD-HI as in ADHD-I.
6.2. Decision-making problems as an ADHD symptom
Decision-making problems means problems with making decisions, not problems with the quality or correctness of decisions made.
Decision-making problems seem to be significantly more frequent in ADHD-I than in ADHD. This suggests that the different manifestations have different neurophysiological correlates.
While ADHD-HI correlates more strongly with decision-making that is too spontaneous, too impulsive, in ADHD-I the ability to make a decision is often massively impaired. Even simple decisions can trigger the feeling of being overwhelmed.
One study found that the decision quality problems of adolescents with ADHD resulted less from risk affinity than from suboptimal, because less complex, judgmental decision making that did not consider all factors relevant to decision making.1
6.3. Neurophysiological correlates of thinking blocks and decision making problems
High levels of norepinephrine block the PFC via alpha-1 adrenoceptors and shift behavioral control to posterior brain regions.2345 Since the PFC is very important for weighing multiple decision options, blockade of the PFC naturally leads to increased decision-making problems.
Decision-making problems are to be distinguished from difficulties of time perception.6
For more details, see ⇒ Neurophysiological correlates of thinking blocks and decision problems
6.4. Thought blocks as symptoms of stress
Thought blocks are also known to be symptoms of severe stress.78
Dekkers, Huizenga, Popma, Bexkens, Zadelaar, Jansen (2019): Decision-Making Deficits in Adolescent Boys with and without Attention-Deficit/Hyperactivity Disorder (ADHD): an Experimental Assessment of Associated Mechanisms. J Abnorm Child Psychol. 2019 Dec 28. doi: 10.1007/s10802-019-00613-7. ↥
Ramos, Arnsten (2007): Adrenergic pharmacology and cognition: focus on the prefrontal cortex. Pharmacol Ther. 2007 Mar; 113(3):523-36., Kapitel 6 ↥
Birnbaum, Gobeske, Auerbach, Taylor, Arnsten (1999): A role for norepinephrine in stress-induced cognitive deficits: α-1-adrenoceptor mediation in prefrontal cortex. Biol. Psychiatry 46, 1266–1274. ↥
Ramos, Colgan, Nou, Ovadia, Wilson, Arnsten (2005). The beta-1 adrenergic antagonist, betaxolol, improves working memory performance in rats and monkeys. Biol. Psychiatry 58, 894–900. ↥
ähnlich: Arnsten (2000): Stress impairs prefrontal cortical function in rats and monkeys: role of dopamine D1 and norepinephrine alpha-1 receptor mechanisms. Prog Brain Res. 2000;126:183-92. ↥
Shapiro, Huang-Pollock (2019): A diffusion-model analysis of timing deficits among children with ADHD. Neuropsychology. 2019 May 16. doi: 10.1037/neu0000562. ↥
Bartsch (2015): Störungen der Gedächtnisfunktion, Seite 44, zitiert nach Schmidtke (2013), Funktionelle Gedächtnis und Konzentrationsstörungen ↥